


Let's play murder

by cookieswillcrumble



Category: Sherlock (TV)
Genre: Gen, Meta
Language: English
Status: In-Progress
Published: 2014-02-25
Updated: 2014-05-17
Packaged: 2018-01-13 17:46:33
Rating: Not Rated
Warnings: No Archive Warnings Apply
Chapters: 12
Words: 11,506
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1235479
Author URL: https://archiveofourown.org/users/cookieswillcrumble/pseuds/cookieswillcrumble
Summary: <blockquote class="userstuff">
              <p>I am doing this to put the whole “but she didn’t mean to kill him” to rest because I don’t believe anyone can actually make that statement without first being full informed. So I am going to attempt to fully inform you, to the best of my medical abilities, and then I don’t ever have to see that comment on my dash ever again until the new series airs and we finally find out the truth of intents and what not.</p>
            </blockquote>





	1. "I've always been able to trust my senses, the evidence of my own eyes"

Firstly, how am I even qualified to make a post on this?

Well, I happen to have trained as a surgeon. As part of my training, not only did I have surgical stints where I went into theatre to operate on patients but I also worked in a number of Emergency Departments. Trauma and life threatening emergencies fueled my existence! It is important to appreciate and incorporate basic knowledge of human anatomy and physiology as well as recognise a vast array of pathologies to be able to come to an accurate diagnosis. Only then can one start to formulate a management plan for the patient.

I also just so happened to have taught anatomy in college. I did this for two years and would have taught a wide range of students. Not just medical students, but physiotherapy and pharmacy students are also required to have a certain basic knowledge of anatomy. As anyone who was examined by me would vouch, I was tough but fair. My approach to teaching anatomy was more clinically based, to make it more realistic. No one cares what the root value of the phrenic nerve is or that the inferior vena cava is on the right side to the vertebral column, unless they are made to appreciate the consequences to the patient of not knowing. These are pass/ fail questions. It is drilled into us from day one. _"C3, 4 and 5 keep the diaphragm alive."_ We have bloody mnemonics for just about everything! Some are impossible to forget.

Currently, I am training in radiology. Again anatomy comes into play. It's all about anatomy at this point! I am looking into the human body on a daily basis. It is my job to look at films, be they x-rays or CT scans and come to a diagnosis based on the findings, as well as suggest management options and follow up imagining. What I love about radiology is that it touches on all specialties in medicine. There is not a medical field out there that will not require imaging for their patients at some point or another. From paeditrics, to traumas, to geriatrics, everyone ends up getting some sort of radiological investigation.

Based on my knowledge of human anatomy and experience as both a surgeon and a radiologist, I am approaching this meta post from a very cold and analytical place where anatomy is key, especially when it comes to Sherlock getting shot.

 

So....

_"Let's play a game"_

  __

_"Let's play murder"_

**Notes for the Chapter:**

> Many thanks to sherlockspeare for allowing me to use her gorgeous gif!


	2. "It was worth a wound"

Let us look at all the [scenes](http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13) where Sherlock was shot and then make or deductions from there shall we?

 

First time we see the entry shot, which appears to be in the lower chest/ upper abdomen on the right side.

 

 Wound is not gushing like a geyzer and is oozing dark blood, therefore venous blood and not arterial.

  

This is the closest shot to the entry wound and we can clearly see that it is to the  **right side of the sternal border**  and  **superior to the xiphoid process**.

 

~~poor baby pirate *sobs forever*~~

 

Checking now for continuity errors and let me tell you something, these guys have done their homework and aren't fucking messing around.

 

We can clearly see that the entry wound is still in the same position, roughly  **2-3 finger breadths (4-6 cm) inferior to the nipple**  and  **lateral to the right sternal border**. It is within the confines of the ribcage.

 

The entry wound remains in the same position, at about the 5th intercostal cartilage/ space. Again we see dark blood that is not actively pumping, so again  **venous blood**. Also note, the outline of the lower border of the rib cage. This just goes to show that this is also a  **chest**   **wound as it is contained within the ribcage**.

 

Can you see it? The gunshot wound? In relation to the right nipple? It appears to be more likely to be at the  **5th intercostal cartilage**. This is important. Remember this cause I will be talking about this in detail.

 

Yeah, my money is on 5th intercostal cartilage and not the space here.

 

And this is the shot that defies all medical logic, but I digress. 

 

**Notes for the Chapter:**

> All screen caps can be found at kissthemgoodbye.net


	3. "You see but you do not observe"

**Notes for the Chapter:**

> This is a very long post on anatomy.

Now, I am going to try and explain this as I would have to my first year anatomy students, by going through the basics one step at a time.

 

This is the basic outline of the thorax. What is important to note here, is the position of the nipple. In a  _lean_  adult male, the nipple is located at the 4th intercostal space (ICS) in the mid-clavicular line (an imaginary line drawn vertically down from the midpoint of the clavicle).

The [sternum](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-thoracic-wall) (breastbone) is made up of three "bones": manubrium, body and xiphoid process (which may be cartilaginous up to middle life).

There are [12 paired ribs](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-thoracic-wall), 7 (upper) true ribs and 5 (lower) false ribs.

There is a very easy way to [count these ribs](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/ch03-reader-sa-0), which is particularly important when considering penetrating injuries or diagnostic/ therapeutic procedures. Going down the jugular notch, the manubrium is palpated till a ridge or "dip" is felt; the point of articulation of the manubrium with the body of the sternum. This is known as the sternal angle and is one of the most important anatomical landmarks. Along the edge of this, the costal cartilage (CC) of the 2nd rib may be palpated, and you can begin counting from there. Below each rib is its corresponding space, i.e. below the 3rd rib is the 3rd ICS, and below the 4th rib is the 4th ICS, and so on. 

Note, the function of the ribs is not only for respiration, but also to contain and protect the vital organs; lungs, heart, liver, etc.

 

Here, we can see a single rib (as luck would have it, the 5th rib) and its attachments posteriorly to the thoracic vertebrae and anteriorly, through the 5th CC, to the  _body_  of the sternum. Remember that the nipple is just in the space above this (the 4th ICS).

The ribs don't come across and attach in a perpendicular fashion, but are situated more obliquely. Imagine someone hugging you from behind. Yeah, that's right. Like that.

 

Note the structures directly behind the 5th CC and at the edge of the body of the sternum, the  **internal thoracic (or mammary) artery and vein** , as well as  **intercostal nerve and its branches**. Injury to these, as would be expected with a penetrating wound, and would result in bleeding into the pleural cavity (which is termed a [ **haemothorax**](https://www.inkling.com/read/rosen-barkin-5-minute-emergency-medicine-consult-4/section-h/hemothorax)), as well as  **paralysis of the intercostal muscles and sensory loss to the skin**  supplied by the nerve segment.

Let's not forget, the rib/ CC was also involved so a  **[rib fracture](https://www.inkling.com/read/essential-clinical-anatomy-keith-moore-4th/chapter-1/ch01-bluebox-1)**  is possible leading to damage to underlying structures. In this case, it would be to the lung and may also lead to a  **[pneumothorax](https://www.inkling.com/read/250-cases-in-clinical-medicine-baliga-4th/case-108/pneumothorax) ** (air collecting in the pleural cavity and if this compresses the mediastinal structures it is called a [ **tension pneumothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-12/tension-pneumothorax), which is a life threatening condition).

 

The  **right parasternal lymphatic chain and nodes** , pictured above, may also be injured and  _may_  lead to a [ **chylothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-22/chylothorax).   

 

Before we delve an deeper, I would like to point out the  **pectoralis major muscle**  which overlies most of the superior surface of the thorax.

Its sternal head originates from: the sternum, upper 1-6 CC and the external oblique aponeurosis. Penetrating injury at the level of the 5th CC is surely going to  **injure the pectoralis major muscle**  as well. 

 

* * *

 

Now I am going to go through the structures contained in the thoracic cavity that are relevant to Sherlock's injury. The first thing I am going to discuss is the [pleural cavity](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-pleural). The CC of ribs 1-5 and (parts of) ribs 1-8 on the right have been removed in the above image. The blue lining is the parietal pleura which lines the inside of the pleural cavity. Anteriorly on the right side, the parietal pleura is very near to the midline behind the sternum and up to the 6th costal cartilage.

 

The visceral pleura is the lining which is adherent to the lungs. Therefore, on the right side, the lung extends anteriorly and medially up to the 6th CC. Note the mid-clavicular line I mentioned earlier. The nipple would be found in the 4th ICS at that line.

A potential space is found between the two linings, which contains serous fluid that reduces friction between the lungs and the chest wall cavity during respiration. It is in this space that  _ **air**_ ,  _ **blood**_  or fluid may collect. 

 

I am only going to discuss the right lung here. As you can see, it is made up of three lobes: superior, middle and inferior. These lobes are divided by fissures: horizontal (which is only found in the right lobe) and oblique. It is important to note the position of the middle lobe.

  


The middle lobe is contained between the two fissures. The horizontal fissure extends anteriorly up to the 4th CC and the oblique fissure up to the 6th CC anteriorly. Therefore, I am assuming it is safe to say that when Sherlock was shot, there is a high likelihood that the  **right middle lobe**  may have been in the way of that bullet.

 

This the the [right lung](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-pleural) and the major structures related to it.

 

 

Note the relation of the inferior surface of the lung to the diaphragm, and the area on the medial (inner) side of the lung in which the heart would lie as well as the position of the inferior vena cava (IVC). These will now be discussed individually and in detail.

 

* * *

 

The green lining shown represent the [mediastinum](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-mediastinum) which is divided into two part by an imaginary line drawn horizontally along the sternal angle: superior and inferior.

 

We are interested in the inferior mediastinum which is further divided into three parts: anterior, middle and posterior. Only the thymus, in children, is found in the anterior mediastinum so we'll ignore that. Let's look at the middle mediastinum which contains Sherlock's heart.

 

The heart is contained in a pericardial sac, like the lungs. There is a potential space between the visceral and parietal layers of the serous pericardium which contains serous fluid which allows for reduced friction when the heart is beating. In this space  _ **air**_ ,  _ **blood**_  and fluid may collect. Do you see the pattern here? The fibrous pericardium, which contains it all, is as the name implies fibrous and is therefore immobile. So anything that would collect there would just lead pressure on the heart and may cause  **cardiac tamponade** , which is a life threatening condition.

 

These are the [heart borders](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/ch03-reader-sa-0). On the right, note that the heart border (which is made up of the right atrium, the chamber of the heart that receives deoxygenated blood through the IVC) extends from the 3rd CC to the 6th CC. Where did we say Sherlock was most likely shot again? 5th CC? Had it been real life, and not TV magic, Sherlock would have suffered  **[penetrating cardiac injury](https://www.inkling.com/read/textbook-of-critical-care-vincent-abraham-kochanek-moore-fink-6th/chapter-207/penetrating-cardiac-injury), ** resulting in **cardiac tamponade**  or at the very least a  **haemopericardium** (blood collecting in the pericardial space).

 

The right phrenic nerve (which provides both motor and sensory supply to the diaphragm) is seen to the right side of the heart and travels below the diaphragm in the opening through which the IVC emerges.

 

We can appreciate it here better where is exits the diaphragm along with the IVC through central tendon of the diaphragm.  **Injury to the right phrenic nerve**  (as this is likely since we can see how close it is to the IVC) would lead to [ **unilateral diaphragmatic paralysis**](https://www.inkling.com/read/essential-clinical-anatomy-keith-moore-4th/chapter-1/ch01-bluebox-1).

* * *

 

Let's talk about the [diaphragm](https://www.inkling.com/read/gray-anatomy-students-drake-vogl-mitchell-2nd/chapter-3/regional-anatomy-diaphragm) now. This is a dome shaped musculotendinous structure which separates the contents of the thorax from the abdomen. Anteriorly, it is attached to the xiphoid process and the costal margins of the thoracic wall. It is one of the three structures involved in respiration as described in the image above. 

 

The right dome of the diaphragm is higher than the left, due to the liver, and during expiration may be as high as the 4th ICS/ 5th rib on the right side. Purely due to its attachments anteriorly, I am finding it very difficult to visualize how Sherlock would have sustained a liver injury (which he did) without  **injury to the right dome of the diaphragm**.

The [liver](https://www.inkling.com/read/grays-anatomy-standring-40th/chapter-68/liver) extends superiorly under the diaphragm to the level of the right 4th ICS (approximate location of the nipple in the male). 

 

 

This is the space within the abdomen that would be occupied by the liver. Note the position of the IVC behind the liver.

> **[Penetrating trauma accounts for 90–95% of abdominal vascular injuries, with a high mortality due to the nature of these injuries as well as associated injuries to other intra-abdominal organs. It is important to consider intra-abdominal injury with all penetrating injuries from the nipples to the upper thighs.](https://www.inkling.com/read/vascular-and-endovascular-surgery-beard-gaines-loftus-5th/chapter-9/abdominal-vascular-injuries) **
> 
> **[The retro-hepatic IVC should be approached with extreme caution. If haemorrhage can be controlled with packing this should be the method of treatment. Various strategies to repair these injuries have been described but the prognosis is still dismal, with a reported mortality of 70–90%.](https://www.inkling.com/read/vascular-and-endovascular-surgery-beard-gaines-loftus-5th/chapter-9/abdominal-vascular-injuries) **

Mortality means death. Death in 70-90% of cases. D E A D. 

 

 

Here we see the inferior surface of the liver. Imagine yourself sitting inside the abdomen, facing forward, and looking up.

The liver is divided into a right and left lobe. There are 2 ways of doing this:

 

1.  _Anatomic lobes_ : divided by the falciform ligament resulting in four lobes (right,left, caudate and quadrate). 

The falciform ligaments has its anterior attachment to the post surface of the right rectus muscle. This is important when you note the attachment of the rectus abdominis muscle.

This is the [ **right rectus abdominis muscle**](https://www.inkling.com/read/elseviers-integrated-anatomy-and-embryology-bogart-ort-1st/chapter-5/muscles-of-the-anterior) with the rectus sheath dissected and opened up. I am showing you this image to point out the superior attachment of the rectus abdominis. It is up to the 4th CC and includes the 5th CC. Where was the shot fired? Exactly!! Possible injury to the rectus muscle would include tearing of the muscle and bleeding, resulting in a  **[rectus sheath haematoma](https://www.inkling.com/read/sahani-abdominal-imaging-1st/chapter-134/traumatic-abnormalities)** , since the injury is well above the arcuate line (pictured above).

 

2.  _Functional lobes_ : divided by an imaginary line drawn from the IVC to the gallbladder, with the  **hepatic veins**  (which drain venous blood into the IVC) further dividing the liver into eight segments.

Can you begin to appreciate how vascular the liver is? It receives 1500 mLs of blood per minute!! That is 1.5 Liters!!  

This is the  **hepatic artery**  with its branches that supply oxygenated blood to the liver (roughly 25% of the blood supply to the liver). The anatomy here is variable so I will not be going into great detail.

 

Here we see the  **portal vein** and its intra-hepatic branches (which deliver the remaining 75% of blood to the liver). The anatomy of this is also variable, so I will not go into any great detail, but I am sure you are getting my point here. 

 

This is an image of the major vessels responsibly for supplying (hepatic artery and portal vein) and draining (hepatic veins which are not seen here but would drain into the IVC). Note how closely related they all are.

 

* * *

 

We are assuming, with a high probability of likelihood, that the IVC was involved when Sherlock was SHOT, and I am now going to explain why.

 

This is the Advanced Trauma Life Support classification system of haemorrhagic [shock](https://www.inkling.com/read/greenfields-surgery-scientific-principles-practice/chapter-8/types-of-shock) by the American College of Surgeons.

It took Sherlock all of, what, 3 seconds before he went into shock? And he did go into shock! Molly confirms this: blood loss (first thing that is going to kill him) leading to shock (next thing that is going to kill him).

Judging by the his mental status alone (since he did lose consciousness and we aren't informed anything other than "We are losing you" by John), we can probably classify it as Class IV shock.

> [ **_Class IV:_ Loss of more than 40% of blood volume (more than 2,000 mL), representing life-threatening hemorrhage. Symptoms include marked tachycardia, a significantly depressed systolic blood pressure, and narrowed pulse pressure or unobtainable diastolic pressure. The mental status is depressed and the skin is cold and pale. Urine output is negligible. These patients require immediate transfusion for resuscitation and frequently require immediate surgical or other (e.g., angiographic embolization) intervention.** ](https://www.inkling.com/read/greenfields-surgery-scientific-principles-practice/chapter-8/types-of-shock)

Sherlock would have lost over 2000mLs (2 Liters) of blood. Remember the liver receives 1500mLs/min of blood through the portal vein (mainly) and the hepatic artery. This is draining into the IVC via the hepatic veins. The IVC is on the right side of the vertebral column and is directly behind the liver. The IVC, the conduit of venous return from the lower half of the body below the diaphragm, would ascend directly through the opening in the diaphragm to drain into the right side of the heart.


	4. "If I wanted poetry"

At this point I am going to refer to the [transcript](http://arianedevere.livejournal.com/67635.html), particularly the lines relating to Sherlock's injury. There is quite a bit of information we can glean from the dialogue and this will lead to some interesting revelations as we go further down this bottomless rabbit hole.

 

 

**MOLLY:**  It’s not like it is in the movies. There’s not a great big spurt of blood and you go flying backwards.  
 _ **The impact isn’t spread over a wide area.**_  
 _ **It’s tightly focussed, so there’s little or no energy transfer.**_  
You stay still ...... and the bullet pushes through.  
You’re almost certainly going to  _die_ , so we need to focus. 

 

* * *

 

****

**MOLLY:**  It’s all well and clever having a Mind Palace, but you’ve only  ** _three seconds of consciousness left_**  to use it. So, come on – what’s going to  _kill_  you?

**SHERLOCK:**   _Blood loss_.  
 **MOLLY:**  Exactly.

**MOLLY:**  Forwards, or backwards? 

 

* * *

 

****** **

**ANDERSON:**  One hole, or two? 

 

* * *

 

****

**MOLLY:**  Is the bullet still inside you ...... or is there an exit wound? It’ll depend on the gun. 

 

* * *

 

 

**MYCROFT:**  You’re a very stupid little boy. Mummy and Daddy are very cross ...... because it doesn’t matter about the gun. 

You saw the whole room when you entered it. What was directly behind you when you were  _murdered_?

**YOUNG SHERLOCK:**  I’ve not been  _murdered_  yet.

**MYCROFT:**  Balance of probability, little brother. 

 

* * *

 

 

**SHERLOCK:**  The bullet’s still inside me.  
 **ANDERSON:**  So, we need to take him down backwards.  
 **MOLLY:**  I agree. Sherlock ...... you need to fall on your back.  
 **ANDERSON:**  Right now, the bullet is the cork in the bottle.  
 **MOLLY:**  The bullet itself is blocking most of the blood flow.  
 **ANDERSON:**  But any pressure or impact on the entrance wound could dislodge it.  
 **MOLLY:**  Plus, on your back, gravity’s working for us. 

 

* * *

 

 

**MOLLY:**  You’re going into  _shock_.  
It’s the next thing that’s going to  _kill_  you.  
 **SHERLOCK:**  What do I do?  
 **MYCROFT:**  Don’t go into  _shock_ , obviously. 

 

* * *

 

 

**MOLLY:**  Without the shock, you’re going to feel the pain.  
 _ **There’s a hole ripped through you.**   **Massive internal bleeding**_.  
You have to control the pain.

 

 

**Notes for the Chapter:**

> I got the transcript off the amazing Ariane DeVere's LiveJournal.
> 
> Screencaps were again from http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13


	5. "Is that British Army Browning L9A1 in your pocket..."

The last time I studied forensic pathology was roughly 10 years ago, so I am aware that I will be taking some liberties here just so that I can make sense of what type of injuries Sherlock may have sustained when he was shot by Mary's gun.

Speaking of guns...

This is the little shit that had the bullet that was aimed at and shot into Sherlock (remember kids: guns don't kill).  

It's a hand held [semi-automatic](http://emedicine.medscape.com/article/1975428-overview#aw2aab6b3) with a silencer attached.

 

You can see here, at the left hand side, that the casing (the bright yellowish thing) was ejected as the gun was fired. That is how we know it's a semi-automatic. 

 

This is a clear shot of the bullet hitting Sherlock. We can see a blush of blood on the right side of his lower chest just as the bullet hits.

The gun is held at arms length and pointing at level with the floor (which is seen clearly in the screencap showing the fired casing), which would  _technically_  cause the bullet to penetrate straight through in a perpendicular fashion.

 

Mary is not  _that_  short (or that far from Sherlock). She is [163cm](http://www.imdb.com/name/nm0007893/bio?ref_=nm_ov_bio_sm) (5'4"). Sherlock is [183cm (6')](http://www.imdb.com/name/nm1212722/bio?ref_=nm_ov_bio_sm) tall. There is about half a foot difference between them. Also, we see here that there is less than 10 feet between them, foot to foot. If her shooting arm was extended forward, that would leave a distance of about  _six feet between the silencer and Sherlock_. Therefore, the angle of the gun when she points and shoots is plausible.

 

* * *

  

Let's have another look at the entry wound, shall we?

This is the clearest shot we have. Notice the edges of the wound. 

[Firearm  _entrance wounds_  are typically round to oval, with smooth edges and a zone of epidermal abrasion surrounding the wound edge. This abrasion is caused by the rubbing or scraping of surrounding skin surfaces by the bullet as it indents the skin before perforating it.](http://emedicine.medscape.com/article/1975428-overview#a30)

[ **If the bullet strikes perpendicular to the skin, the abrasion will be of uniform width around the wound.** ](http://emedicine.medscape.com/article/1975428-overview#a30)

Does this sound like a fair description? Yes, I think so too.

Handguns or pistols are generally described as causing low velocity projectiles.

> [The terms ‘high’ and ‘low’ velocity are not as useful as ‘power’, incorporating projectile mass, and even less useful than the concept of energy transfer. Although most rifles are ‘high-powered’ and most pistols/revolvers ‘low-powered’, projectile energy is only one determinant of wound magnitude. A ‘high-powered’ rifle bullet may cause less trauma if it misses ribs and traverses a short path through the chest than **a ‘low-powered’ pistol bullet that fragments after hitting a rib**. Having said this, the kinetic energy of a rifle bullet is many times that from a pistol.  **Hitting bone, a pistol bullet frequently causes a simple fracture** , whereas a rifle bullet causes fragmentation and extensive bone loss.](https://www.inkling.com/read/bersten-ohs-intensive-care-manual-7th/chapter-85/penetrating-ballistic-trauma)
> 
> [There are two primary traumatic effects of a projectile; formation of a  _permanent or a_   _temporary cavity_.](http://emedicine.medscape.com/article/1975428-overview#aw2aab6b5)
> 
> [Bullets cause crushing/laceration, shock waves and cavitation.  **Crushing and laceration are caused by the direct force of the bullet, and are the principal mechanisms of injury due to ‘low-powered’ firearms.**  Serious injury generally results only if vital structures are damaged. Shock waves are caused when a ‘high-powered’ bullet compresses tissues.](https://www.inkling.com/read/bersten-ohs-intensive-care-manual-7th/chapter-85/penetrating-ballistic-trauma)
> 
> [As the tissues continue to move away from the bullet track, subatmospheric pressure sucks in debris. The  _temporary cavitation_  disrupts cells and their microcirculation, producing dead tissue around the wound track  _up to_  30–40× the diameter of the bullet.](https://www.inkling.com/read/bersten-ohs-intensive-care-manual-7th/chapter-85/penetrating-ballistic-trauma)
> 
> [As kinetic energy increases by the square of bullet velocity, a high-velocity projectile will tend to cause a larger temporary cavity than a lower velocity one. Because of this,  **temporary cavities are usually not significant in handgun injuries** , but they are of much greater significance in high-velocity rifle wounds.](http://emedicine.medscape.com/article/1975428-overview#aw2aab6b5)

Remember when we examined the dialogue I said that things would get interesting? Well, here we are! 

If you recall, Molly did clearly describe Sherlock's injury:

> _**There’s a hole ripped through you.**   **Massive internal bleeding**_.
> 
> _**The impact isn’t spread over a wide area.** _   
>  _**It’s tightly focussed, so there’s little or no energy transfer.**_

All the evidence regarding wound ballistics supports this 100%. So even though the bullet was perpendicular to Sherlock's body when it hit, what happened to the bullet inside depends on the exact location of the hit. Since I am leaning towards 5th CC, its course may have easily been altered as it would less likely fragment the bone and would simply cause it to fracture.

Points that need to be considered would be the actual type of bullet that was used, as this may have turned into fragments after hitting the rib, but since we don't have this information we will have to do with out. That is a meta post for a terminal ballistics expert. 

 

* * *

 

But, I will leave you with one final note regarding bullets:

> [Bullets are typically made of lead or lead–antimony, as high density preserves kinetic energy in flight. Pure lead bullets melt at velocities of greater than 2000 ft/s (≈600 m/s), necessitating at least partial ‘jacketing’ in a more resilient substance (e.g. aluminium, brass, or steel). Military bullets (according to Third Hague Convention of 1899) must be completely encased in a ‘full metal jacket’ (a misnomer, as the base of the bullet may have no covering), which reduces deformation in tissues and so causes less ‘unnecessary suffering’. By increasing the chance of non-lethal injury, an unintended consequence is to increase combat effect: a wounded enemy soldier consumes more resources than one who is dead. In contrast, hunting rifle bullets have a soft lead or polymer tip, increasing the chance of killing quickly and so reducing suffering. Bullets with hollowed-out points have greater air drag and shorter range, but deform so extensively that exiting the target is unlikely. This is beneficial for police wishing to reduce the chance of harming bystanders.](https://www.inkling.com/read/bersten-ohs-intensive-care-manual-7th/chapter-85/penetrating-ballistic-trauma)
> 
> [Doctors are sometimes asked by people concerned with compliance with the laws of armed conflict to classify the type of bullet found in a patient.  ** _Any_  bullet can deform and fragment**, so finding no intact fully jacketed bullets does not allow this question to be answered.](https://www.inkling.com/read/bersten-ohs-intensive-care-manual-7th/chapter-85/penetrating-ballistic-trauma)

**Notes for the Chapter:**

> Thank you to everyone who commented and for the feedback on the gun and ammo! I will be updating this in the near future with the relevant information for completeness.


	6. "Once you rule out the impossible, whatever remains-however improbable-must be true"

We have gone through the anatomy of our region of interest (mainly the chest and upper abdomen) and we have also reviewed terminal ballistics (though with limited information, especially concerning the actual bullet itself). 

So, summary of the facts:

  


 Mary shot Sherlock dead on.

 

 Sherlock goes into SHOCK.

 

 Sherlock DIES.

 

 Sherlock pulls a lazarus because "gay love can pierce through the veil of death". 

 

Sherlock recovers in hospital, and is half way on the mend surrounded by flowers from all the people who love him.

 ~~I wonder which ones were from John. Probably the purple ones.~~  

 

Sounds about right, right?

Yeah.... I don't think so either.

~~Not the flower though. They are definitely from John.~~

 

The bullet went in an oblique course once it was inside Sherlock. That is the only was I can explain how he did not having a penetrating cardiac injury. But it doesn't spare him from other, some just as serious and life threatening, injuries. 

* * *

 

Let's tally up the score then, shall we?

I am going to review all of Sherlock's injuries (from the outside in) by dividing things up into lists (I LOVE lists!!) and seeing what pathology each injury would result in.

 Definite Injuries:

  * Right Pectoralis Major muscle
  * Right Rectus Abdominis muscle: [**Rectus sheath haematoma**](https://www.inkling.com/read/sahani-abdominal-imaging-1st/chapter-134/traumatic-abnormalities)
  * 5th CC/Rib: [**Rib Fracture**](https://www.inkling.com/read/fracture-management-primary-care-eiff-hatch-3rd/chapter-18/rib-fractures-after-trauma)/ [**Haemothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-22/haemothorax)/ [**Tension Pneumothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-12/tension-pneumothorax)/[ **Liver Injury**](https://www.inkling.com/read/core-topics-in-general-emergency-surgery-paterson-brown-5th/chapter-13/management-of-abdominal-injury)
  * Internal Thoracic artery and vein: [**Haemothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-22/haemothorax)
  * Middle lobe of the right lung: [**Pneumothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-12/pneumothorax)
  * Diaphragm
  * Liver: **[SHOCK](https://www.inkling.com/read/greenfields-surgery-scientific-principles-practice/chapter-8/types-of-shock)/ [Liver Injury](https://www.inkling.com/read/core-topics-in-general-emergency-surgery-paterson-brown-5th/chapter-13/management-of-abdominal-injury)**
  * IVC: [**SHOCK**](https://www.inkling.com/read/greenfields-surgery-scientific-principles-practice/chapter-8/types-of-shock)/ **[Vascular Injury](https://www.inkling.com/read/vascular-and-endovascular-surgery-beard-gaines-loftus-5th/chapter-9/abdominal-vascular-injuries)**



 I have no doubt about these whatsoever.

Possible Injuries:

  * 5th intercostal neurovascular bundle: **Paralysis of intercostal muscles and sensory loss**
  * Right parasternal lymphatic chain: [**Chylothorax**](https://www.inkling.com/read/crash-course-respiratory-system-hickin-renshaw-williams-horton-szar-4th/chapter-22/chylothorax)
  * Right atrium of the heart: [**Cardiac Tamponade**](https://www.inkling.com/read/sabiston-spencer-surgery-chest-sellke-8th/chapter-75/penetrating-cardiac-injury)
  * Right phrenic nerve: [**Unilateral diaphragmatic paralysis**](https://www.inkling.com/read/essential-clinical-anatomy-keith-moore-4th/chapter-1/ch01-bluebox-1)



The reason I have the list with possible injuries is to prove a point.

Had Sherlock been in a different phase of respiration (remember ribs move with respiration), the course of the bullet would have been completely different, and Mary would have broken his heart. Quite literally.

**Notes for the Chapter:**

> Screencaps were used form http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13


	7. "The universe is rarely so lazy"

  


Will I explain why? 

* * *

The scene where Sherlock first bumps into Mrs. Watson and she actually shoots him. ~~What you doin, CAM?~~

* * *

The scene where Sherlock explained to John: Mary's option to shoot to kill. ~~What you doin, CAM?~~

* * *

~~~~

The scene where Sherlock explained to John: Mary's option to shoot to surgery. ~~What you doin, CAM?~~

* * *

 

Is that a mobile on the floor, at arms reach from you, that  **you**  used to call the ambulance? Is that what you, **CAM** , kept reaching for in 3 different shots of the same scene? 

 

_"What do we say about coincidence?"_

 

**Notes for the Chapter:**

> Thought this might be interesting since it's 3:30 am at the moment!
> 
> Again the screencaps where used from http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13


	8. "You're a doctor. In fact, you're an Army doctor."

 I am going to go through [ **John's CV**](http://archiveofourown.org/works/503732) just to clarify a few points:

I am including this because it is CANON, but I am also going to be painfully honest here. 

I am not impressed by this. Not really. 

It only tells us that he obtained his undergraduate degree from  **[King's College London with the MBBS](https://www.kcl.ac.uk/medicine/study/ug/mbbs/index.aspx) ** in June 2004. Generally speaking, in the UK and Ireland, you don't start to practice medicine till about a month after graduation. Graduation would be in June (I graduated in June) and then you start out into the big bad world in July. The rule of thumb was, never get sick in July because that is when all the newly graduated Bambis will be starting ~~and there is a good chance of patients actually dying as a result.~~

So, he then starts in July 2004 a  **pre-registration house officer**  (which is basically an intern) and apparently he only did the minimum 6 months for [General Medical Council registration](http://www.gmc-uk.org/education/undergraduate.asp). Then he was a  **Senior House Officer** for only two months, from February to April 2005. 

> [Foundation training is made up of F1 (foundation year one) and F2 (foundation year two). These two years effectively replace what was formerly known as the Pre-registration House Officer (PRHO) year and the first year of Senior House Officer (SHO) training.](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)   
>    
>  [Foundation doctors are trained and assessed against specific competencies set out in the curriculum agreed with the General Medical Council (GMC).](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)   
>    
>  [Training takes place in a range of settings including acute, community, mental health and general practice.](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)   
>    
>  [The F1 year will typically consist of at least three-months in a surgical post and at least three-months in a medical post to provide a broad range of experience prior to full GMC registration. Regular work based assessments take place, and trainees must maintain a national learning portfolio in order to progress.](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)   
>    
>  [The F2 year usually consists of four varied three-month placements. Many programmes include at least one placement in a "shortage specialty", academic medicine or general practice, giving trainees the opportunity to try a number of different specialities before making a decision about which specialty training programme they would like to pursue. Again, there are regular work-based assessments against standards of competence.](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)   
>    
>  [By the end of the Foundation Programme, all doctors will have achieved the same generic clinical and non-clinical competencies defined in the national curriculum, irrespective of the precise nature of their placements over the two years.](http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/foundation-training/)

Like, that's it? Are there pages in his CV we are not seeing?  _Nothing after 2005?_ But, he graduated and became a  _bloody doctor!!_

So, what I am meant to understand by this is that he finished up his two year foundation training in the span of  _eight months_  (assuming he started his PRHO in July 2004), and then probably dilly dallied for a while before he signed up to join the RAMC in Afghanistan for three years before he got shot and was invalidated back to London after a certain amount of recovery time and then went on to meet his future partner in crime-solving-escapades on the 29th of January ?2010???

What I am trying to prove with this is that no matter how brilliant a show is, and make no mistake "Sherlock" is definitely stocked to the brim with brilliance, they inevitably will have some TV magic. 

Having said that, we don't get any information about his time in the army. 

What does John remind us in [The Sign of Three](http://arianedevere.livejournal.com/66078.html)?

> **JOHN:** I’m John Watson, Fifth Northumberland Fusiliers. Three years in Afghanistan, a veteran of Kandahar, Helmand, and  _Bart’s bloody Hospital._ Let me examine this body.

Whatever about his under-graduate experience in London, which was nothing fantastic if I am being brutally honest, I dare say that there was more to his CV that meets the eye. He doesn't really mention his medical/ surgical experience in the RAMC. He would've worked in a medical/ surgical capacity, as well as being a soldier, so why not mention  _this_  experience? 

This was something that I always wondered when ever I re-watched TBB. I get a sense that he is at constant battle with these two sides of himself: doctor and soldier. They don't really go hand in hand. Is he, like Sherlock, married to his work (doctor-ing) but is keeping a mistress (soldier-ing)? Is that his dirty little secret? He never fails to remind us, or Sherlock for that matter, that he was a soldier, while Sherlock never fails to remind him that he was also a doctor. Definitely morally dubious, Dr./Capt. Watson.

I think I am delving into a parallel meta now, so I am going to reign it in before I hurt myself.

 

* * *

 

 **JUST TO BE CLEAR:**  John Watson is not entirely an idiot you know!

Thank God for Sherlock, for clearing up all this mess for us in [ **ASiP**](http://arianedevere.livejournal.com/43794.html). 

> **SHERLOCK:**  You’re a doctor. In fact you’re an Army doctor.  
>  **JOHN:**  Yes.  
>  **SHERLOCK:**  Any good?  
>  **JOHN:** _Very_  good.  
>  **SHERLOCK:**  Seen a lot of injuries, then; violent deaths.  
>  **JOHN:**  Mmm, yes.  
>  **SHERLOCK:**  Bit of trouble too, I bet.  
>  **JOHN** **:**  Of course, yes. Enough for a lifetime. Far too much.  
>  **SHERLOCK:**  Wanna see some more?  
>  **JOHN** **:**  Oh  _God_ , yes.

It honestly doesn't matter what may have happened in the Foundation years, ~~as I am blaming that on the medical advisors for the show at this point tbh~~ , and I truly believe John is, in one word, _BRILLIANT_! At the end of the day, **HE WAS A BLOODY ARMY DOCTOR!** That shit is **HARDCORE!** Can you even imagine what the learning curve for a junior doctor in the army is like? In a war?

As a doctor and a soldier, I would expect John's knowledge of anatomy to be of surgical effectiveness in its purest form. He is a doctor who went to WAR. Surgeon most likely, especially considering his profile in his CV. Unless the RAMC were being attacked by the sniffles and the army needed someone to hand over paracetamol and a box of tissues, it would be safe to say that John was practicing/ training as a surgeon. Knowledge of anatomy is essential, as well as [BLS](http://www.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/BasicLifeSupportBLS/Basic-Life-Support-BLS_UCM_001281_SubHomePage.jsp), [ACLS](http://www.heart.org/HEARTORG/CPRAndECC/HealthcareProviders/AdvancedCardiovascularLifeSupportACLS/Advanced-Cardiovascular-Life-Support-ACLS_UCM_001280_SubHomePage.jsp) and [ATLS](http://en.wikipedia.org/wiki/Advanced_trauma_life_support) to name a few of the basic life saving courses he would have to be certified in. 

Even though John may be out of practice with surgical procedures after the war, most doctors are expected to be up to date with their BLS/ACLS as these are updated fairly regularly by the American Heart Association and certification only lasts for up to two years. Speaking for myself now, as someone who previously practiced surgery, I can honestly say that there were very few courses I did that were as enjoyable as the ATLS course and I doubt that John would easily forget such basic stuff after having had AMPLE practice in Afghanistan. Did I mention there was a WAR there? 

So, with his extensive background knowledge in trauma/ ballistic injuries, and the fact that he would have been keeping up to date with the latest in forensics so that he may keep up with Sherlock as well as reading medical journals, like the [NEJM](http://www.nejm.org/),  so that he is up to date with medical stuff for the clinic he now works in, it is not unreasonable to think that John has some of his basic anatomy knowledge well intact as well.

No doctor worth their salt does not know what the diaphragm is or its nerve supply, or that the IVC is on the right side and the Aorta on the left. Maybe only if that physician works in a lab, would I not expect to remember the level of detail discussed, but even at that it would be expected that a doctor knows where the lungs, heart and liver are in relation to each other the same way it would expect that the general population know that people tend to have two ears, two eyes, one nose and a mouth.

With that in mind, any doctor in the same situation as John was would be jumping to the worst case scenarios, especially one with a surgical background. In Sherlock's case that wasn't so hard. I literally formed a drop down list, within seconds, of all the possible injuries and penetrating liver injury was only one of them.

It would be extremely difficult for John to react, the way he normally does with other patients, when it comes to Sherlock, though. 

 

* * *

 

Shall we review some screencaps to further enlighten ourselves with the amazingness that is BAMF!Dr.JohnWatson?  _Oh, God, yes!_

I am going by memory on this, so someone correct me if I am wrong or if I am missing something here. I will review only the scenes where John is physically with a person in need of doctorly assistance. Not the clinic ones from TEH though. Those are a bit boring for John. Or the bodies at the crime scenes/morgue. That's more Sherlock's area.

 

[ **ASiB** ](http://sc.aithine.org/sherlock/201/index.html)

This is the first time we see John being his lovely doctorly self. He starts by checking to make sure that Kate is breathing.

 

While simultaneously checking for her pulse. He later goes to look for a first aid kit.

 

John, not looking happy with Irene having drugged an ex-drug-addict.  

 

Can you appreciate the deep lines of concern in his face??

 

Back to bed drugged-y-locks! 

 

~~Yeah I had to include this shot. For scientific reasons, obviously.~~  

 

[ **TRF** ](http://sc.aithine.org/sherlock/203/index.html)

Here is our little soldier, ploughing through the crowd to get to his Sherlock.

 

He knew the answer already. Anyone who falls off a building from that height has little to no chance of survival.

He still checked though. He had to do this for himself, more than anything else.

 

John, the soldier, shoved back by a senior nurse and he just went with it.

He was in the way. Emotionally compromised. Caring was not going to help save Sherlock.

 

[ **TSoT** ](http://kissthemgoodbye.net/sherlock/thumbnails.php?album=12)

What is this now? Not letting the big scary army guy hold you back from examining the body like a BOSS!

 

Being all doctorly and captainy and giving orders like a BOSS!

 

Comforting the patient like the delicate hedgehog you are.

 

[ **HLV** ](http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13)

Again, here is John pushing his feelings aside to check on his best friend's fiance.

 

OMG, no! That's not how you do it! You don't start slapping the patient's face! You know that! But this is not any patient, now, is it?

 

This is Sherlock and he is bleeding,  _again!_ For realsies this time! Look, someone put a **bullet in his chest**!

 

Yes, call 999! Get help! Someone, please! 

 

_Sherlock! **We are losing you!**  Sherlock?_

 

__

Jesus Christ, _no!_ Not  _again,_ Sherlock!! You are  **bleeding internally**? 

 

Help him, please! You might need to  **re-start his heart**  on the way?

 

~~_This is why we can never have nice things._ ~~

 

The last time we see  _Dr_. Watson is when he is trying to revive his drugged  _pregnant_  wife.

An innocent life is still involved and John will always step up to the plate if his emotions allow it.

 

* * *

 

We have all seen John pull a gun without hesitation countless times! I don't think we appreciate that he has a completely different side when it comes to helping innocents. It's gentler but still authoritative, due to his double background as a soldier and a surgeon. 

I honestly think that at the time, John was  _emotionally_  compromised. Being a doctor or a soldier does not stop him from being  _human_. The general public has this misconception that doctors are built like boulders. They are not. These situations are generally worse for those with a medical background. 

_"Will caring about them help save them?"_

_"Caring is not an advantage."_

_"Sentiment is a chemical weakness found in the losing side."_

It is generally considered unethical to operate on or treat loved ones in life and death situation. There are greater chances of making mistakes, getting in the way, being over bearing, etc. Leave it to the professionals.

I honestly don't believe that John could swallow that "it was surgery" pill Sherlock was trying to feed him. Although _certain_ anatomybe variable, it is unlikely to be so drastically variable that the chest cavity contents completely air bend a point blank bullet. There is a lot more to this than meets the eye.

The only reason I knew Sherlock would survive his injuries was because there was still about an hour left to the show. Longest death scene in history? Thankfully, no. It is by the grace of film making magic that Sherlock survived.

I hope to make some sense of this in the upcoming chapters that will be examining Sherlock's management while in the ambulance/ operating theater /private ward, as well as further looking into this _surgery_ business.

**Notes for the Chapter:**

> I had to write this up mainly for myself, and in hopes that it is somehow relevant to what is to come.  
> I feel for John in this series. He has been through Hell and back and Hell and back and Hell and... I think you can see where I am going with this. It is too much for anyone! Saying that he is a doctor or a soldier is not an excuse to keep throwing Sherlocks off a building to see how long it will take the man to crack. He is, at the end of the day, still human. 
> 
> Again the transcripts are off Ariane DeVere's LiveJournal at http://arianedevere.livejournal.com/43794.html
> 
> Season 2 screencaps from http://sc.aithine.org/sherlock/index.html
> 
> Season 3 screencaps from http://kissthemgoodbye.net/sherlock/index.php?cat=4


	9. "You got that from one look?"

We need to remember that not only was  **[Sir Arthur Conan Doyle](http://www.biography.com/people/arthur-conan-doyle-9278600)**  a physician, but he also based Sherlock Holmes on a real life doctor.  **[Dr. Joseph Bell](http://www.youtube.com/watch?v=8dui_OjW4j8)** , one of the pioneers in forensic pathology. 

Dr. Bell was a [ **Fellow of the Royal College of Surgeons of Edinburgh**](http://en.wikipedia.org/wiki/Fellowship_of_the_Royal_College_of_Surgeons), which was the highest level that may be achieved in the surgical field at the time. He proved that simple observation can easily lead one to an accurate diagnosis. Of course, a lot of study had to go into what he did, but it doesn't change the fact this it **is** humanly possible to do what Sherlock Holmes does. And it was a doctor that started it all. It is not magic, just simple observation.

Observation (or inspection as we call it now a days) is also a basis for the teachings in medical school. During clinical years, med students are taught to observe, over and over again. This is practically tattooed on our skin! That itch to observe is insistent and eventually just second nature to most physicians as they progress along their career paths.

It is through this force of habit that I am looking into this. Yes, I _know_ it is fiction, I am very aware of that fact, but I can't help it! It's my job to inspect, percuss, palpate and auscultate. I reach my conclusions based on scientific facts as well as taking into consideration the _highest_ probability of likelihood. Common things are common. If you hear hooves and all that. 

The amount of medical inconsistencies is just jarring against the backdrop of how much they actually got spot on. We have all watched shows that involve our jobs/ careers/ hobbies and sat back and thought, at one point or another: Well, that's nice, but that is not how it _technically_ happens.

If the show is going to do this:

 and then show us this:

then there are going to be some issues.

They are trying to tell me that I have tickets to see a one-night-only aria performance by opera diva "The Liver", when in actual fact I end up witnessing a violin quartet featuring "Heart & Co." instead. Co. in this case being: lung, liver and IVC. What I am trying to say, and I appreciate that I might be doing this poorly, is that a shot in that _anatomical_  location, renders an _isolated_ liver injury **impossible**.

When it comes to looking for medical inconsistencies in a show, after a medical advisor plans the scene, the creators would be better off if they could find a few greasy-haired, sleep-deprived, caffeine-marinated final year medical students and show them the final cut. Final year medical students have the eagle-iest of eagle eye based on the amount of condensed knowledge they would have during the time they are preparing for their final exams. They would be more than happy to give criticism. That practically feeds them.

* * *

 There is only one thing the creators showed us, so far, that is _indisputable_ :

 

Sherlock  _technically_ died!

 

The surgeons had walked away from him, 

 the lights dimmed 

 and we saw the flatline.

All of this leads me to believe, that he died. If intentions were not to kill, but to incapacitate, he would not have _died_ in the first place. 

Medical Fact: He DIED and _then_ came back from the DEAD!

I really cannot overemphasize this enough, if I am going to stick to the facts. His survival, thus far, is due to artistic liberties taken by the creators/ medical advisors for dramatic effect. Based on the anatomical location of the entry wound, I can only draw to the conclusion that he should have, by all means, died instantly. That shot, based on that  _anatomical_ location, was fatal. Could there have been another way to place the shot to make it more plausible yet _still_ maintain dramatic effect? It's possible. 

* * *

The ongoing debate about Mary's  _intentions_  will go on till Anderson shaves his beard, or Greg finds his division, or Mycroft finds his "goldfish", or Mrs. Hudson's exotic dancing video is released...... or till we get the new series.

I can safely tell you one thing: the "surgery" in itself is complex. There is a substantial amount of intra/ post operative complications. And, let's not forget that Sherlock had been doing **drugs** the night before/ morning of the shooting. He tested positive in the lab. That would also affect his physiological response to trauma. There are just soooo many things to be take into consideration. The frustration is endless!! 

"Why no kill shot to the head?"  

This is _my_ list of reasons, so far:

  1. Mary couldn't do it and sentiment got the better of her.
  2. Moriarty wants Sherlock's head displayed over his fireplace and a bullet would have ruined the effect.
  3. The government wanted Sherlock's brain preserved, for science. 
  4. Mary wanted Sherlock to die slowly and painfully and for John to witness him taking his dying breath.
  5. Mary was trying to buy herself time to escape, since she knew that John would stay back and look after an incapacitated Sherlock rather than chase after someone who had left a dead one.



~~If any of the above does turn out to be the case then I would like to point out that I totally called it! Except for number 5. Credit to that will have to go[Slithytove](http://archiveofourown.org/users/Slithytove) who pointed this out to me in the comments.~~

See, I am not good at this side of the analysis, so I am not going to attempt it _**ever**_ again.

From this point onwards, all I can do is go through the facts from a medical perspective and point out which bits were right and which bits were not so right. I am hoping that along the way I **_may_** be able to find an answer to the whole Mary thing, one way or the other. I am aware that I might **not**. There are so many other aspects to consider going through this, such as the hand of the law in this scenario, but this is not something I am going to touch on since I have no knowledge in that department. Potential meta for someone with a legal background? YES!

* * *

I am  _trying_ to be as objective as humanely possible. I have my  _own_  opinions, as a fan of the show, which I came to based on my medical background. These opinions are  _my own_ , and I will endeavor not to subject them onto anyone. I will, however, question everything since I do not consider Sherlock  _himself_  to be a reliable narrator based on his past history.

**THIS**

**HISTORY**

~~Sherlock Holmes, you are a back-stabbing, heartless, manipulative bastard.~~

He may have been lying, but then again he might not have been. I am, therefore, taking what he said with a pinch of salt, until the truth unfolds.

* * *

 I was trained to be skeptical and to recognize when I am being lied to so that I may actively look for the truth myself. As part of my job, this is important, since the nature of the lie may be detrimental, either to the patient or myself. As a result, I would be very hesitant to go by what the writers, or in some cases the characters, _tell_ me about/ during the show until I have _seen_ and _examined_ the evidence with my own eyes. 

 

They have revealed things to us

for reasons that were later made clear.

 

They have concealed things from us:

for reasons yet to be revealed.

* * *

 If the creators are putting the time, thought and effort to present us with something as breath-taking, mind-boggling, gut-wrenching, tear-inducing, fanfic/art/meta-inspiring as "Sherlock", then it is only expected that certain aspects of the show, especially a show with such a long hiatus between series, will be going under the microscope. The medical stuff is just one of these. If I had done this for the House fandom, we would all be witnessing the end of time together! 

If the only thing this post will serve as is some sort of medical reference for our wonderful fanfic writers, then that is something I can live with and would consider a win all around. ~~  
~~

**Notes for the Chapter:**

> I just want to thank everyone who has commented so far! I honestly loved all the feedback as it has helped me immensely in organizing my thoughts! 
> 
> I would also like to apologize for the grammatical/ spelling errors. I have seen them and they mentally taunt me, but I will discipline them at a later date.
> 
> If any of you have enjoyed this, then I would love it if you go and thank the following people:
> 
> 1\. http://arianedevere.livejournal.com/  
> 2\. http://kissthemgoodbye.net/sherlock/index.php  
> 3\. http://sc.aithine.org/sherlock/  
> 4\. http://mid0nz.tumblr.com/
> 
> This would not have been possible without them! 
> 
> I am going to have to leave this here for now, since I have about 12 hours of exams to start studying for and I think I have procrastinated enough.
> 
> Things you can look forward to (and I am putting this as a guide for myself!):
> 
> -Favourite screencap from HLV (trust me this will be relevant)  
> -Lighting the scenes (this will set the mood)  
> -Scenes from the ambulance to the OR to the private ward to the paramedics: general review.  
> -ATLS/ SHOCK  
> -BLS/ ACLS/ Cardiac Arrest  
> -Effects of drugs (remember: Sherlock was doing drugs the night before/ morning of the shooting)  
> -Scene will then be deconstructed into what was accurate and what was not (each scene will be turned into a chapter so roughly 4 chapters)  
> -Surgical scars  
> -Surgery  
> -Post-operative recovery period  
> -Post-operative complications.
> 
> YIKEES!! 14?? Am I counting this right?? Give or take, that is the plan, in case any of you were wondering. 
> 
> And yes, I have taken the first part from the Chapter on John's CV. I did that because I felt that it was out of place there and serves its purpose better on this "disclaimer" chapter.
> 
> If I do change titles, or chunks of paragraphs around, it's because I am a scatter brain when it comes to writing. I am more comfortable wielding a scalpel than a pen (or keyboard)!


	10. "Please, God, let me live"

**Summary for the Chapter:**

> Let's go through all the scenes that were in any way involved with Sherlock's medical/surgical management.

**Notes for the Chapter:**

> This will be a really quick overview, since we will be going through each scene in great detail in the following chapters, so don't worry if it doesn't make that much sense now. I promise I will do my best to break each one down and it will all come together at the end. I hope it will in any case!

There are four instances that we can examine further:

 

  **The Ambulance:**

****

We are not shown much here. We see Sherlock lying on a gurney and was dragged into an ambulance. They rip off his shirt to expose his wound, possibly to assess the type of injury. I am _presuming_  that they also slapped on some defibrillator leads on him so that they can monitor his heart and zap him if need be.

  


Here is the ~~sweet baby pirate~~  patient fitted with an oxygen face mask with a reservoir bag. In the acute setting, the oxygen he would have been receiving would be at 100%.

* * *

** The Operating Theatre **

At Sherlock's head is the anaesthetist. He has intubated Sherlock using an endotracheal tube with is connected to an ambu bag which the anaesthetist can hand pump to control the amount of oxygen Sherlock is receiving. At the same time, we can see the rotating nurse (I am going with nurse since this person is not "scrubbed") doing chest compressions while Sherlock is receiving continuous oxygen. The other person (possibly the surgeon or scrub nurse) in this screen cap is holding something in their right hand. I want to say chest paddle, but maybe its just a swab to clean Sherlock up and get him ready for surgery. 

There is a lot going on in this scene.

Let's first look at what has been done for the ~~sweet baby pirate~~ patient.

  1. He has two 14 gauge (orange) peripheral intravenous (IV) cannula in both arms. These are the biggest fuckers around with a flow rate of 240 mls/min!! 
  2. Two bags of blood (I am assuming that this is not crossmatched blood) and a bag of IV fluids as well (which I will _assume_ is Hartmann's solution which would be used in a surgical setting).
  3. Chest leads have been placed (in the correct position!) 
  4. Blood pressure cuff is on the left arm, which would inflate at set intervals to monitor Sherlock's vitals.
  5. He is still intubated and was being ventilated until the team called it. ~~If they are walking away, then they have already called time of death.~~



The entourage:

  1. At the head is the anaesthetist. His job is to maintain oxygenation and monitor vitals as well as administer drugs. ~~He would also adjust the height of the table if asked politely.~~  
  2. On Sherlock's left would be the surgeon. If they want to access the liver, the operating surgeon would be on the left hand side of the patient.
  3. Next to the anaesthetist, is the rotating nurse. This is the person who would get surgical equipment from the store room/shelf that is not readily available if the operating surgeon asks for it. I wasn't sure initially, but the short sleeves and the fact that this person is not actually scrubbed makes this the only probability.
  4. On Sherlock's right side, furthest away by Sherlock's feet, is the scrub nurse. This is the person who would hand the surgical instruments to operating surgeon, so they need to be scrubbed. Initially I wondered if this was the assistant surgeon, who would also have to be scrubbed, but they would not be able to handle instruments _and_ assist at the same time. So no assistant, only scrub nurse. ikr.



The equipment:

  1. The defibrillator is in the corner of the room. Pretty pointless having it there if you ask me.
  2. There is a suction device to the right of Sherlock that would be used to "suck the blood" when they open up so that the surgeon can clear the operating field and identify the source of bleeding.
  3. The instruments' trolly by Sherlock's feet is looking a little sad with the "dentist supply" of instruments on it.
  4. The anaesthetist's monitor is exactly where it should be. This will keep tabs on Sherlock's vital: blood pressure, respiratory rate, heart rate, etc. 



 Speaking of heart rate..

 ...just to be clear they show us again... all alone... all hope is gone...

 Great ~~John~~ Scott, IT'S A MIRACLE!!!

 Oh yeah, Sherlock also has central IV line. This would go directly to his heart to pump the fluids in faster.

* * *

  **The Private Ward  **

This is the immediate post operative period. Here we have Sherlock, unrealistically, hooked up to a nasal cannula that would deliver oxygen. We can also see the heart monitor leads and a bag of IV fluids. A small mercy, indeed.

I am going to _assume_ that this is the 7th post op day (the same day he escaped hospital which was a week after the surgery).

So what do we have:

  1. 14 gauge peripheral IV access in the left arm, which I _assume_ is connected to the morphine pump.
  2. Central IV line in the left Jugular vein, through which I am _assuming_ he is receiving the IV fluids.
  3. Heart monitor leads in the correct position. 
  4. Blood pressure cuff (deflated at the moment, as it inflates at set intervals.)
  5. Pulse oximeter on the right middle finger to measure the oxygen saturation in the blood as well as the heart rate.
  6. Mepore dressing (to cover up the ~~stupid~~ Kocher's incision).



 Pretty much same stuff here.

~~Not an excuse to shamelessly eye a half naked Sherlock.~~

Oh yeah, and the vitals monitor.

  The turquoise thing that Sherlock is fiddling with is a morphine pump.

~~Nothing to do with a presumably fully naked Sherlock under the sheets.~~

~~And John's lovely flowers.~~  

* * *

  **The Flat**

[When they arrive at the scene, paramedics will assess the patient's condition and take potentially life-saving decisions about the treatment needed. If appropriate, they'll then administer the treatment.](http://www.nhscareers.nhs.uk/explore-by-career/ambulance-service-team/careers-in-the-ambulance-service/paramedic/)

Paramedic number one: carrying, what I _think_ is, a [heavy duty carrying sheet](http://www.spservices.co.uk/item/PAXBags_PAXHeavyDutyCarryingSheet_64_24_4716_1.html) (that rolled up red thing on his shoulder). 

 Paramedic number two: carrying a bag with medical supplies.

[They'll administer oxygen and drugs and use high-tech equipment, such as defibrillators, spinal and traction splints, and intravenous drips, as needed.](http://www.nhscareers.nhs.uk/explore-by-career/ambulance-service-team/careers-in-the-ambulance-service/paramedic/)

And here we are, back again at full circle, to the oxygen mask with a reservoir bag that would deliver 100% oxygen ~~to the sweet baby pirate who is bleeding internally and who might need his heart restarted on the way.~~

**Notes for the Chapter:**

> I apologize for the delays in getting back to this. The exams were a bitch and I only got back from London four days ago. A bit knackered if I am honest. 
> 
> I have had this chapter half ready ages ago and decided to just finish it and put it out there so that I will be able to get back in the swing of things.
> 
> I will have to watch all of Sherlock again (yes all 3 series again) before I get to the technical bits. I have a feeling that this will somehow help me with this process (even if it doesn't I think I am due a re-watch!).
> 
> I also have quite some research to do. Medical papers and surgical texts to consult. I need to talk to an actual hepato-biliary surgeon about some of the technical stuff. 
> 
> I can't thank you guys enough for the comments and criticism and kind words, it has motivated me so far and so long as there is interest I will use that as fuel to keep going through this. It is going to take time, but I plan to finish it!
> 
> Again, thanx to kissthemgoodbye.net for the screen caps!


	11. "You've always counted and I've always trusted you"

**Summary for the Chapter:**

> All things Molly, because Molly is AMAZING!!!

**Notes for the Chapter:**

> This took me a while because I am not a writer and I decided to diverge a bit from my comfort zone and go gooey and mushy since I have had to watch the shooting seen so often now. I have found the one silver lining in it, and it is my new found appreciation for BAMF!Molly!!! The more I think about her, the more I love Molly Hooper!!

You see this little squirrel here? This child is the reason we even have a third series. Yup. Without this unlikely hero, our protagonist would have surely met his untimely demise. Were it not for her unappreciated existence, as well as her unacknowledged significance in our "hero's" life, we would have all moved on or just lived off parodies and fanfiction for the rest of our lives. Not that there is anything wrong with either, but it is nice having new material for said parodies and fanfics, right? 

It is times like this when I really wish I had a grasp of my emotions so that I could convey my thoughts with out sounding like a combination of mentos, 7up and a box of rice crispies mixed together. *sighs* ~~I really wish I was a writer right about now~~. 

This woman is just so wonderful and I am going to go through all the reasons why and try not to make a balls of the whole thing. I had truly underestimated and dismissed her nearly completely as a result of the first two series. But now, and especially after the mind palace scene in HLV, I have come to re-evaluate my entire opinion of her.

Let's start with her career.

She is a specialist registrar (SpR) at the Barts and The London NHS Trust. Now, what does all that even mean?

Let's go back to ASiB. The morgue scene where Sherlock goes to see Irene Adler's "not her face". Mycroft, ever the gentleman, tells her "Thank you, Miss Hooper" before going after Sherlock. Why am I even bringing this up you say? Well, initially, when I heard that, I never would have thought that Molly was in a medical field. The reason for this now I realised was that the whole series is from John's POV. I am not saying that he thinks any less of her in any way or that she is not on level with him as a colleague, just that he doesn't think much of her one way or the other. Maybe just "the girl in the morgue with the cat and a huge crush on Sherlock". Nothing special. 

That picture though, her ID badge, made me question what Mycroft had labelled her instantly when I found out she was an actual medic. I think now that we know she is in fact a doctor, the " _Miss_ " could mean something else all together. 

In the UK and Ireland, when a person obtains their [Membership in the Royal College of Surgeons](http://en.wikipedia.org/wiki/Membership_of_the_Royal_College_of_Surgeons) (which one can obtain in a two year period while working as a senior house officer in surgery), one is given the title of Mr/Miss. That "Miss" in "Thank you, **MISS** Hooper" _could_ be Mycroft's way of addressing her by her actual title. So, she may have surgical training, which is not unreasonable if she entered a field like forensic pathology. 

Now I am sure you are asking yourselves at this point: How does one even get into Forensic Pathology in the UK? Well, as luck would have it, I went along and did some high tech research via google to figure this out for everyone! I am going by my understanding of the system, though I have never had to apply for a forensics SpR post, but I had looked into it for radiology (though I did not end up applying ~~long story and kicks self up the backside with a very long blazing pitchfork~~ ). 

I went on the [Royal College of Pathologists](http://www.rcpath.org/training-education/training-education) site and found HEAPS of information. I am going to condense it to basic relevant facts. First off, it's forensic _histo_ pathology, and not just plain old forensic pathology. So according to their [curriculum of forensic histopathology](http://www.rcpath.org/Resources/RCPath/Migrated%20Resources/Documents/T/Curriculum%20Forensic%20Histopathology%20.pdf) (and _assuming_ that this is what Molly is doing), it would take roughly 5 years and 6 months to obtain a [certificate of completion of training](http://www.rcpath.org/training-education/cct-specialist-registration/cct-application-pack.htm) (CCT). These years are divided in stages A-D. The stage during which independent work is expected is from Stage C and beyond. What does this mean in terms of time and conditions to get to this point? Stages A and B are basic histopathology training which would take roughly 24 months (30 months if an extra six months is required for Stage B) to complete and during this time one must be successful in the Part 1 [FRCPath](http://www.rcpath.org/examinations/status-of-frcpath.htm) (fellowship in the royal college of pathologists exams) by Stage A. Once this is achieved, a person may then apply to a forensic histopathology training programme (Stage C and D). Stage C includes a minimum of 30 months training and Stage D about 6 months. In years this is roughly 3 years ~~and I can't believe I had to use a bloody calculator for that!!~~  

God bless the writers of the show for keeping her as an SpR for all these years so that she may one day save Sherlock!! She was independently working on cases for the police since 2010, and possibly helping ~~our baby pirate~~ Sherlock for longer! It is now 2014! They could have made her a consultant by now. No, not a consultant _detective_ , the medical kind. I mean, if you are going to be working with NSY you would at least want a nice cushy position and a few shiny letters in front of your name. They really need to make this woman a consultant in the next series. She has been in training long enough. 

 

* * *

 

 Let's re-cap the mind palace scene in HLV because, let's face it we are all just masochists here:

 

 Sherlock gets shot.

 Alarm bells ring. All systems GO!

 Activate Mind Palace (MP).

 And just look at that curve ball from the left field!

It's Molly!! Molly Hooper!!

The first person Sherlock goes to when shit hits the fan and a bullet hits his chest!!!

 She is not condescending, not judging him

 She is all facts and professionalism with only a taste of her little quirks that have managed to make a home in the MP.

 All calm and pleasant smiles and laying down the facts.

Guiding Sherlock and bringing him around to follow and examine the problem scientifically.

Bringing us to my favourite transition in Sherlock which was when we went from this

to this!!

Molly is just killing it here!!! I mean, just look at how she practically blends into the background!!

She practically **is** the light!! This is her comfort zone, where she is the number-one-Alpha-dog!

And this is where Sherlock keeps her in his MP.

 This is the first time Molly guides Sherlock around his MP. 

 She is going to examine the **BODY** with him.

 Talk him through the case.

 Let's have a looksie shall we? But where are you Sherlock? You need to be here for this.

  _You're almost certainly going to die, so **we** need to focus. _

~~_*slaps baby pirate hard*_ ~~

  _I said focus!_

_~~*slaps him even harder*~~ _

 Bringing him there _physically_ to go through the evidence so that he is not just hearing her in the background.

  _It’s all well and clever having a Mind Palace, but you’ve only three seconds of consciousness left to use it. So, come on – what’s going to **kill** you?_

This is Molly LITERALLY guiding his thought process. This is the voice he chooses in his head for cool and calm under pressure.

Not John. (Even I will admit that now).

 So they have to come up with a plan, right?

 Back up to the real world. 

Let's clue for looks there.

  _One hole, or two?_

_It'll depend on the gun._

Bless his heart, he is going through his military ~~kink~~ catalogue of hand held pistols.

 That is until Mycroft comes in, sneering and looking down at him and gets him to do what he does best: deduce.

"No broken glass, that bullet's still in your ass" 

_So, we need to take him down backwards._

Anderson actually says something clever!!

The IQ of the street is raised by a caterpillars hair's breadth!!!

 

Molly agrees!!

 But look, where is Anderson going now?

You said you will take me down backwards.

~~That just sounded so much filthier in my mind.~~

 Molly? What are you doing? Are you leaving too? 

No silly kitten. She only went behind you. 

  _Sherlock, you need to fall on your back._

_Fall now._

_**I** _

_**WILL** _

****_**CATCH**_

  ** _YOU_  
**

**_ AGAIN _   
**

 And we are back now, a second time, in the safety of the MP Morgue.

  _You’re going into **shock**._

_It’s the next thing that’s going to **kill** you. _

What ever will I do now, Miss Hooper?

  _Don’t go into **shock** , obviously. _

Whoever the fuck asked you Mycroft?? 

 Imma go deep in my MP and run away from you and your bloody East Wind!!

 fuck wrong door

~~*sobs forever*~~

Not even Redbeard can make this better. And he's a fucking puppy!!! 

~~I don't even know anymore please don't judge me~~

Look who's there again blending with the light? 

  _Without the shock, you’re going to **feel** the pain._

_There’s a hole **ripped** through you. **Massive** internal bleeding._

_You have to **control** the pain._

OH GOD!! CON TROL CO NTRO L C ONT ROL!!

 

I HAVE TO FIND IT!!

 so I will go where no one can follow

* * *

The thing about Molly is, though I liked her, I had never been  _passionate_  about her before this. She was always this timid little mouse, with an impossible crush on an impossible man and it just did't do anything for me. It may have grated on my nerves a bit, if I am being completely honest, since it was a bit too close to home. 

We've all been there, had the hots for someone knowing all the while deep down in our bones that it was a one-sided affair. You know, when you're so nervous that you say the most awkward things and put makeup on because you know you are going to see the object of your obsession and despair and just always end up putting your two left feet forward in every conversation. I had a crush on a consultant when I was an intern and tried to blend with the wall whenever he passed by in the hallway. True  ~~and sad~~  story. For this reason alone, I am willing to cut the girl some fucking slack.

This girl is not just a girl. She is a woman!! All adult and authoritative in Sherlock's mind. Not the shy projection we see in the the first two series. Sure, she still had a wee crush on sherl-lollipop at the beginning of TEH, but she did get over it eventually. She never lost herself in the process. She is still sweet, loyal and dependable. She was there for Sherlock to fall back on not once, but TWICE!!! The fact that she is the one who practically navigated the whole MP scene in HLV speaks volumes. How many of us would have thought that John would be the one to do that, hm? Honestly now, cause I was a bit surprised that we didn't see John even once there. I think that Sherlock definitely had his reasons, but that does not make Molly second choice. She is important to him in ways different from John. John who was one of the people Sherlock jumped for, ran into fire for, **came back from the dead for**. He may not have a romantic/ physical relationship with her but that does not mean he does not value her opinion and he would seek her out in times of trouble, since to date she has never failed him. Not once.

Bless you, Miss hooper.

Bless you.  

 

**Notes for the Chapter:**

> Transcript: http://arianedevere.livejournal.com/67635.html
> 
> Screencaps: http://kissthemgoodbye.net/sherlock/thumbnails.php?album=13
> 
> Sorry this took a while, but I hope you realize why this is important. Well, to me it is in any case. I have come to the sore conclusion at this point in my life that writing is fucking hard.
> 
> So, this chapter is dedicated to the writers in this fandom.
> 
> To our meta writers: I can not put into words what your hard work means to me and so many others in this community. Writing is so hard. I have had these words ready well before I could organise the words into my own work. Thank you for the patience in putting down structured sentences, to thoughts I shared, in a coherent manner. Thank you for opening my eyes to gems I could not find the words to describe without the light you reflected. Thank you for taking the time to talk to me and other in the fandom in addressing our fears and concerns, and clearing the fog in our confusion. 
> 
> To our fanfic writers: What you all do will always be appreciated. You have sat with us through our joys, our sorrows, our illnesses, our moments of sheer madness. You have given us so many worlds to explore, endless possibilities to entertain and have proved time and again that not even the sky is the limit. From the depths of my being, I thank you. I do not have the words you all use so eloquently but I hope you realise that so long as you put your words out there, not only will others cherish and devour them, but you will also manage to encourage our future writers to pluck up the courage and do the same. And for them, I thank you again.
> 
> Thank you all and bless you.


	12. Because... you saved my life.

**Notes for the Chapter:**

> THEORIES!! THERE ONLY BE THEORIES HERE!! IF IT BE MEDICINE YEE SEEK THEN SEEK AT THE NEXT PORT!!

**I just realised something** :

In the mind palace scene in HLV (you all know which one), where Mycroft says: 

([source](http://enigmaticpenguinofdeath.tumblr.com/post/73152472598/when-sherlock-has-to-order-himself-to-calm-down))

 

And then we see Sherlock running towards a door:

 

Which was the same door in ASiP that John ran through:

 

So he was hoping to find John there, but instead he got this:

([source](http://melodymelsriver.tumblr.com/post/77734504220/mind-palace-mary-so-mary-watson-who-are-you))

 

Then he goes to Redbeard but since that doesn't work either:

([source](http://doctaaaaaaaaaaaaaaaaaaaaaaa.tumblr.com/post/73176745861/red-beard))

 

Sherlock ended up coming here:

([source](http://www.mtv.com/news/1721614/sherlock-everything-you-missed-on-his-last-vow/))

 

 If he hadn't he would not have heard this:

([source](http://doctaaaaaaaaaaaaaaaaaaaaaaa.tumblr.com/post/73140934218/basically))

 

Then he might not have been able to find the will to do this:

([source](http://sherlockspeare.tumblr.com/post/73135769127/this-is-the-most-beautiful-thing))

 

And he definitely would not have done this:

([source](http://holmesillusion.tumblr.com/post/84949702815/john-watson-is-definitely-in-danger))

* * *

 

But, had Sherlock found John, it could have gone one of two ways:

 

 **First** , Sherlock may have encountered:

but then he would never want to leave.

 

 **Second** (and this is worse, so fair warning):

He may have re-visited all the times he hurt John or the times he was hurt by things John said (which is probable since, well, the deduction scenes in TEH with John's voice berating him) and that might make him never want to go back.

* * *

 

I still stand by my assessment of Molly. She was the one to guide Sherlock through the MP from the get go. Her place is solid. But, I had not realised that John was also in the equation.

Sherlock was seeking John, to "keep him calm". But how would John have done that? If John was all happy memories: **would Sherlock want to leave?** If John would have started shouting abuse at him (which he did in his mind when he was deducing the locked room with the skeleton case in TEH) and that is _probably_  the most plausible theory then: **would Sherlock want to go back?** Those are two very different questions with very different answers, yet both would yield the same result. ~~The maths they taught me in school never fucking prepared me for this shit.~~

Confronting Mary in his MP is what led him to delve into the dungeon of his memories, a place he may have physically been in before. A place he keeps Jim. 

Had Moriarty not pointed out "John Watson is  _definitely_  in danger", would Sherlock have made it out alive? Would he have scaled those metaphorical steps and made it past the light and back into the world of the living? 

**MARY SHOOTING HIM IN HIS MIND PALACE IS WHAT SAVED HIS LIFE.**

Sherlock wasn't lying completely, since it obviously did, and he just omitted that small insignificant detail.

**Notes for the Chapter:**

> I have to thank Wolf Storm (I am a technological ass and I can't tag people, please spread the word) for pointing out to me in the comments that Sherlock was actually trying to get to John when he opened the door on Mary. 
> 
> I have tried to source the gifs (I managed for HLV scenes) but a lot of the others were reaction gifs that I have had in my folder for a while now. If any of these gifs belong to you OR you know who they belong to, I implore you to let me know so that I may give credit where it is due!!! I don't know where I would be without the gif makers in this fandom!!
> 
> I have read Meta on the significance of Mary being there in her wedding dress and shooting him as being symbolic of his actual heartache, but have not read anything about the part where this probably may have been a reason why she saved his life. Since this has been an extremely painful process for me (I swear the number of times I have seen the bloody shooting scene will be what drives me around the literal bend!) I have decided to put up anything that I feel may be relevant in any way regarding the aftermath of said scene. 
> 
> Yeah so, not medical, obviously but meh.
> 
> This is for the fans: I live for the comments and feedback! The only way we will manage to unlock the secrets of Sherlock is to go through the same material over and over till we are nothing but husks of our former selves!! I have met and interacted with a lot of wonderful people on AO3 and tumblr and it has been an absolute joy to get to talk to fans like me from all over the world!! You guys keep me right and I can't thank you enough!! 
> 
> A few notes on what will happen next chapter:  
> I will go through the HEART!! EVERYTHING ABOUT IT! From anatomy to physiology to BLS/ACLS. If you ever wondered why is it that the heart actually beats then I will be answering that age old question next. 
> 
> "When will this happen exactly?" you ask and very rightly so. Soon. I hope. I just quit my shitty ass job on Thursday and am in the process of relocating back to Europe (so that I may finally remove that blazing pitchfork from up my ass) and will follow my dreams there. Life is too short to be miserable, and I am done being miserable. If I can give anyone any bit of advice on life it would be this: If there is anyway you can achieve happiness, no matter how crazy people might think you are, go for it!!! My dream is to one day have a small island with two huts over the water (one with a bedroom and the other with a library/ entertainment room) and wake up every morning and have a dip in the ocean. Whatever gets you through each day right?

**Author's Note:**

> I would like to thank sherlockspeare for allowing me to use her beautiful gif.


End file.
